Perineural spread of cutaneous head and neck cancer. Its orbital and central neurologic complications
P. D. Clouston, D. M. Sharpe, A. J. Corbett, S. Kos and P. J. Kennedy
Department of Neurology, Repatriation General Hospital, Concord, Sydney, Australia.
The ability of cutaneous squamous cell carcinoma of the face to cause
ophthalmoplegia or central nervous system dysfunction via perineural spread
is not well recognized. Five patients presenting to a general neurology
unit are described in whom partial or complete ophthalmoplegia developed
following fifth and seventh cranial nerve involvement by cutaneous squamous
cell carcinoma. Two patients subsequently developed a contralateral
hemiparesis; and one, multiple cranial nerve palsies as the tumor spread
centrally. Normal radiologic findings or complete healing of the primary
skin lesion caused delay in the diagnosis in three of the patients. When
ophthalmoplegia or central nervous system dysfunction develops as a
consequence of perineural spread of cutaneous facial cancer, management is
palliative.
